Americans with depression are still not achieving optimal outcomes. Up to 25 million Americans have turned to the Internet for some information about depression treatment and many of these have participated in peer led Internet depression support groups. Support groups, even those on the Internet, have led to increased self-efficacy, better self-management and improved outcomes for individuals with chronic diseases other than depression. Alcoholics Anonymous and other 12 step programs have proven valuable in improving the outcomes for many patients with substance abuse. We propose to use the R-24 mechanism to adapt programs and gather preliminary data that will allow investigators to complete more rigorous evaluations of Internet depression support groups that may provide a very cost-effective approach to improving outcomes. After focus groups with patients exploring how they view the advantages and disadvantages with Internet depression support groups we will complete 2 pilot studies. The first study will randomize 225 primary care patients with depression to one of the three groups. The outcome will be accessing and participating in an Internet depression support website. The 3 groups will include: 1) giving a card with only the website address; 2) giving a card with website address, sample postings, and statements addressing common barriers to use; 3) the same as number 2 plus endorsement from their primary care physician. The second pilot study will randomize primary care patients with depression to 1 of 3 interventions: 1) peer support from an ongoing Internet depression group (usual care); 2) a new Internet depression support group entirely peer-led or 3) a new Internet depression support group that is facilitated by a mental health specialist. Outcomes at 1 and 3 months will include reduction in depression symptoms, receipt of guideline concordant depression care, improvement in self-efficacy and satisfaction with the use of Internet depression support groups. We will gather data on possible mediators for how peer support can improve outcomes by assessing the role of providing help to others, getting emotional support, and exchanging information. The data from these pilot studies will allow us to design a more definitive study of the role of Internet peer support groups for patients presenting to primary care settings with depression. [unreadable] [unreadable] [unreadable]